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Chloral hydrate: the good and the bad
J Pershad1, P Palmisano, M Nichols
1Division of Pediatric Emergency Medicine, Le Bonheur Children's Medical Center, Memphis, Tennessee, USA.
Pediatric Emergency Care
|December 23, 1999
Summary
Chloral hydrate overdose can cause central nervous system depression and heart arrhythmias. Following American Academy of Pediatrics guidelines for pediatric sedation can prevent complications.
Area of Science:
- Toxicology
- Pharmacology
- Pediatric Medicine
Background:
- Chloral hydrate (CH) is a common oral sedative-hypnotic.
- Poison control centers receive frequent calls regarding CH overdose.
- CH toxicity manifests as CNS depression and potential cardiac arrhythmias.
Purpose of the Study:
- To summarize the clinical manifestations and management of chloral hydrate overdose.
- To highlight the importance of following established guidelines for pediatric sedation.
Main Methods:
- Review of clinical toxicology data and case reports related to chloral hydrate overdose.
- Analysis of the metabolic pathway of CH to its active metabolite, trichloroethanol (TCE).
- Examination of recommended management strategies for CH toxicity.
Main Results:
- Significant toxicity can occur with ingestions exceeding 1.5 to 2.0 g of CH.
- Trichloroethanol (TCE) is the primary active metabolite responsible for toxicity.
- Management involves gastrointestinal decontamination, supportive care, and arrhythmia treatment.
Conclusions:
- Adherence to American Academy of Pediatrics (AAP) guidelines for pediatric procedural sedation is crucial.
- Proper dosing and administration can minimize the risk of adverse events associated with CH.
- Understanding CH metabolism and toxicity is vital for effective patient management.